HEPATITIS C TRANSMISSION AND PREVENTION
Unprecedented hepatitis C infection rates seen in gay men in Amsterdam PrEP programme
Elske Hoornenborg at AIDS 2018. Photo by Liz Highleyman.
Gus Cairns
Published: 25 July 2018
Regular hepatitis C testing among the HIV-negative gay men and other men who have sex with men (MSM) participating in the Amsterdam pre-exposure prophylaxis (PrEP) demonstration project (AmPrEP) has revealed infection rates via sex previously only associated with HIV-positive gay men. The incidence rate of re-infection in men already treated for hepatitis C was even higher, resembling more the incidence of bacterial sexually transmitted infections (STIs) such as gonorrhoea.
AmPrEP principal investigator Elske Hoornenborg presented findings at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam. She commented that sexual health information and encouragement to avoid behaviours that may spread hepatitis C were important but that frequent testing and immediate hepatitis C treatment were probably the only way to start bringing down the rates of circulating hepatitis C in the gay community.
“It’s important to ask what risks men are taking and help them avoid ones that can transmit hepatitis C. But the ultimate answer to this is to test for hepatitis C as frequently as for other STIs and to provide affordable hepatitis C treatment as soon as possible after testing.”
AmPrEP is still ongoing. Starting in August 2015, it is due to end in December 2020 and has recruited 374 MSM and two transgender women and offers them a choice of daily or event-driven HIV PrEP.
In the meantime, on 10 July, the Dutch government announced that it would support a heavily subsidised price of €12 a month for people buying PrEP for a trial period of five years, forecasting that about 6500 people are expected to join the programme.
In AmPrEP, participants are tested for hepatitis C every six months. The present figures are from August 2015 to December 2017 and most of the people in the study were followed for that whole time period.
At least some of the explanation for rising hepatitis C rates in HIV-negative men – and why the rate has been so much higher in men with HIV – is that ‘serosorting’ behaviour, and especially the type where condomless sex is only practised in men who are confident their partner has the same HIV status as theirs, is now breaking down in the PrEP era, with a lot more sex that can transmit hepatitis C taking place across the HIV serodivide. Read more via AIDSmap